Facilitators and barriers to accessing care by service members and veterans with traumatic brain injury

Research Objectives: 1. To identify how service members and veterans access health care services.
2. To describe facilitators and barriers to accessing health care services.
3. To inform programs and practices to improve access to health care services.

Design: A descriptive, qualitative study guided by a conceptual framework of access to health care services.

Setting: Five Polytrauma Rehabilitation Centers within the Department of Veterans Affairs.

Participants: SMVs (N=55, including 10 caregivers as proxies) who were greater than 2 years post-TBI recruited from the VA TBI Model Systems.

Interventions: Not Applicable

Main Outcome Measures: Facilitators and barriers to healthcare services.

Results: The top four facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate healthcare, family advocates that promoted engagement in healthcare, ability to use VA/Department of Defense/and community facilities, and online resources or equipment. SMVs with severe/DOC TBI also highlighted the role of non-profit organizations in promoting healthcare engagement and the availability of VA specialty residential programs in meeting TBI healthcare needs. Barriers to healthcare access differed across the TBI severity continuum and dimensions of the conceptual framework. Distance to services was uniformly identified as a barrier to seeking healthcare for both patient groups. Having unrecognized healthcare needs in chronic stages and communication breakdowns impacting quality of care were more commonplace for those with greater TBI severity. Those with mild or moderate injury highlighted challenges with specialty programs intended to help pay for services in the community and scheduling challenges limiting availability of services.

Conclusions: Barriers and facilitators exist across multiple dimensions of a healthcare access framework and vary by TBI severity. Findings support current policies and practices to facilitate healthcare access for SMVs with TBI but identify need for tailored approaches for those with greater disability and injury severity.

Author(s) Disclosures: None